Clinical ScienceInterhospital transfer for acute surgical care: does delay matter?

•Data from a retrospective cohort of 2,091 patient transfers from a 200+ hospital referral network.•Delay in transfer request obtained from abstraction of referring facility records.•Delays were more common for older patients and those with more comorbid conditions.•Transfer delay was not associated with post-transfer mortality or hospice discharge.•There is effective triage of high-risk patients.•Further studies should explore other transfer processes and patient outcomes.

BackgroundDelays to definitive care are associated with poor outcomes after trauma and medical emergencies. It is unknown whether inter-hospital transfer delays affect outcomes for nontraumatic acute surgical conditions.MethodsWe performed a retrospective cohort study of patient transfers for acute surgical conditions within a regional transfer network from 2009 to 2013. Delay was defined as more than 24 hours from presentation to transfer request and categorized as 1 or 2+ days. The primary outcome was post-transfer death or hospice. Bivariate and multivariable logistic regression were performed.ResultsThe cohort included 2,091 patient transfers. Delays of 2 or more days were associated with death or hospice in unadjusted analyses, but there was no difference after adjustment. Predictors of post-transfer death or hospice included older age, higher comorbidity scores, and greater severity of illness.ConclusionsDelays in transfer request were not associated with post-transfer mortality or discharge to hospice, suggesting effective triage of nontraumatic acute surgical patients.